Despression theuseofdiagnosis

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Diagnosis is a tool that the doctor uses when he or she has to find out which disease you are suffering from. If you for example present with some symptoms that could be indicative of depression, the doctor will on the basis of your symptoms and his or her own examinations make a diagnosis which is used to find the answers to the following questions:

  • Do you suffer from depression or not?

  • If the answer is yes, what type of depression – mild, moderate or severe?

  • Are you suffering from anything else - physical disease, anxiety, abuse, psychosis?

  • What will the course of the disease be - is there any risk of suicide? Depression always needs to be treated! Do you perhaps need to be admitted?

  • Which treatment is the best in this case - medicine and/or psychotherapy? Or electroshock?

  • Which complications can occur - for example side-effects and/or abuse?

  • Can relapses and new depressions be prevented - do you need to take preventive medicine for a long time??

Diagnosis is also a prerequisite for being able to do research and obtain new knowledge. By using diagnoses we can compare a group of patients with another group of patients and see which one of the treatments is the best. By following patients who have the same diagnosis we obtain new knowledge about

  • The cause of the disease.

  • The course of the disease

  • Possible complications

  • Which treatment is the best?

  • How the disease can be prevented?

The diagnosis systems contain lists of all the diseases that we know of. There are two official diagnosis systems, ICD-10 and DSM-IV, which both contain the psychiatric diseases. Most of the countries outside the USA, the official diagnosis list is ICD-10, while DSM-IV is used in the USA in particular.

Diagnosis are working tools that are continuously being improved and further developed, and the two diagnosis systems therefore have one number (10 and IV respectively) indicating which version it is.

ICD-10

WHO (The World Health Organisation) has for many years administered and published ICD (an abbreviation for International Statistical Classification of Diseases and Related Health Problems). ICD-10 contain all official psychiatric diagnoses. All doctors use them in medical certificates, when you are discharged from hospital and in other official connections.

Diagnoses which are related are bracketed together in the diagnosis system. There is among others a diagnosis group in ICD-10 called "affective mental disorders", where the different forms of depression are listed.

Affect is a designation that both covers your momentary mood and the average mood over a period of time. In affective mental disorders, the mood changes are so severe and prolonged that they inhibit your enjoyment of life.

The affective mental disorders are divided into a long series of diagnoses. It is necessary to divide the affective mental disorders, as depressions present themselves in different ways. Different types of depression require different types of treatment and preventive measures.

Even though your doctor knos that you have a disorder of the serotonin system in the brain, when you are suffering from depression, the doctor can't measure this disorder with a blood test for example or arrive at your diagnosis in this way.

The doctor arrives at the diagnosis depression by asking you questions and by examining you.

The depressive episode is called F32 in the ICD-10 system. The doctor makes this diagnosis after an examination, after which the different ICD-10 symptoms are assessed. The doctor basically follows a questionnaire which has been developed as a kind of screening test for diagnosing depressive diseases.

Figure 1 shows the depression questionnaire. According to ICD-10 the diagnosis of depression applies to the last two weeks, during which every symptom must have lasted for more than half of the time.

An important dimension in the disease depression is the severity of the symptoms. ICD-10 divides the F32 diagnosis into mild, moderate and severe, dependent on how many symptoms are present.

The depression questionnaire is a guide for making an ICD-10 diagnosis but it can never replace the assessment of a doctor. You should be aware of this if you wish to yourself. But if your score from the questionnaire is above 20, you should regard it as an indication of the need for you to see your family doctor.

Beck's Depression Inventory

Another screening instrument that has been named after the American psychiatrist Aaron Beck, who developed it on the basis of theis. It has been widely used all around the world, where the effect of the cognitive psychotherapy is assessed.

Hamilton's Depression Scale

The British psychiatrist Max Hamilton has developed a depression scale, which amongst other things is used by the doctor in an interview with the patient, where he/she asks a number of questions about depression. The doctor can then calculate the degree of the depressive symptoms.

HAM-D is also used when the National Board of Health is assessing whether a new medicinal product should be approved for use against the depression.

Quality of life

The depression involves areas that amongst other things affect daily social functioning. Depression is distinguishable from anxiety for example in the way that it not only affects the actual interest in the daily chores but also the performance of the daily tasks that we have to do. It might be in the form of a lack of energy, less self-confidence, difficulties concentrating etc.

There is evidence to suggest that it is the positive well-being that is reduced, when a depressive disease starts. Quality of life scales have been developed which measure the degree of the positive well-being. One of them is WHO's short five point system, WHO-5, which you can.

The WHO-5 questionnaire uses the following scoring: the scale becomes a kind of percentage scale from 0 (worst possible quality of life) to 100 (best possible quality of life). Studies of the general population of have shown that on average we score 75. If you score around 50 or less, you should fill out the depression questionnaire, in order to find out whether or not there are signs that point towards depression.